Arashi Hiroyuki, Ogawa Hiroshi, Yamaguchi Jun-Ichi, Kawada-Watanabe Erisa, Hagiwara Nobuhisa
Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Am J Cardiol. 2015 Jul 15;116(2):236-42. doi: 10.1016/j.amjcard.2015.04.011. Epub 2015 Apr 20.
Although visit-to-visit variability in systolic blood pressure (BP) is a strong predictor of stroke, the impact on subsequent major adverse cardiac events (MACEs) in patients with coronary artery disease (CAD) in terms of secondary prevention remains unclear. The aim of this study was to clarify the prognostic significance of visit-to-visit variability in systolic BP on subsequent MACE in hypertensive patients with CAD. In the Heart Institute of Japan Candesartan Randomised Trial for Evaluation in Coronary Artery Disease, a total of 2,049 hypertensive patients with CAD were enrolled. Incidence of MACEs in addition to biochemistry tests and office BP were determined during follow-up. Achieved BP was defined as the mean value of systolic BP in patients who did not experience MACE and the mean value of systolic BP before MACE in those who experienced MACE during follow-up. In the present study, 1,734 patients had multiple follow-up visits (≥3 times) until their final follow-up. During a median follow-up of 4.2 years, the primary outcome occurred in 317 patients (18.3%). Visit-to-visit variability of systolic BP was defined as the SD. Participants were divided into equal quartiles based on the mean systolic BP during follow-up and visit-to-visit variability of systolic BP, respectively. Although there was no relation between visit-to-visit variability of systolic BP and the incidence of MACE, the highest quartile based on mean systolic BP showed a significant relation with subsequent MACE. In conclusion, in hypertensive patients with CAD, inadequate BP control is a strong predictor of subsequent MACE, whereas visit-to-visit variability of systolic BP is not.
尽管收缩压（BP）的就诊间变异性是中风的有力预测指标，但在冠状动脉疾病（CAD）患者的二级预防方面，其对后续主要不良心脏事件（MACE）的影响仍不明确。本研究的目的是阐明收缩压就诊间变异性对CAD高血压患者后续MACE的预后意义。在日本心脏研究所进行的坎地沙坦在冠状动脉疾病中的随机评估试验中，共纳入了2049例CAD高血压患者。在随访期间，除了生化检查和诊室血压外，还确定了MACE的发生率。达到的血压定义为未发生MACE的患者收缩压的平均值，以及随访期间发生MACE的患者在MACE发生前收缩压的平均值。在本研究中，1734例患者进行了多次随访（≥3次）直至最终随访。在中位随访4.2年期间，317例患者（18.3%）发生了主要结局。收缩压的就诊间变异性定义为标准差。参与者分别根据随访期间的平均收缩压和收缩压的就诊间变异性分为四个相等的四分位数。尽管收缩压的就诊间变异性与MACE的发生率之间没有关系，但基于平均收缩压的最高四分位数与后续MACE显示出显著关系。总之，在CAD高血压患者中，血压控制不佳是后续MACE的有力预测指标，而收缩压的就诊间变异性则不是。
